Mapping Obamacare by New York City zip code

New York City's uninsured rate fell to historic lows during the past year thanks, in part, to the resources provided by the Affordable Care Act, and an unprecedented surge in Medicaid rolls in immigrant neighborhoods, based on an analysis of recently released state data.

During the last 12 months, more than 660,000 New York City residents enrolled in Medicaid and an additional 157,000 signed up for a private insurance plan through the state's health insurance exchange, which was created as part of the A.C.A.

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In 2012, the last year for which city data is available, there were 1.2 million uninsured adults in New York City. Because no one is tracking how many 2014 enrollees were insured in 2012, it's impossible to say for certain what the city's new uninsured rate is, but the state does know that roughly 93 percent of Medicaid enrollees were uninsured at the time of their enrollment and 63 percent of those who purchased private insurance were uninsured when they enrolled.

That suggests a drop of nearly 60 percent, from 1.2 million New Yorkers to somewhere around 487,000.

Capital took state data released last month and broke down enrollees by zip code. The accompanying chart allows you to see how many enrollees there were in Medicaid, private health insurance plans (Q.H.P.) and Children's Health Plus for each zip code in the city. (An asterisk means less than 50 people enrolled.)

Capital also compared the data to a 2012 map from the city's Human Resources Administration, which broke down the uninsured rate by neighborhood. As you can see from looking at the two maps at the bottom of the article, the highest uptick of Medicaid enrollees (in the first map) was in neighborhoods that had the highest uninsured rate before the A.C.A. took effect (the second map), meaning the impact was felt in areas that needed it most.

In fact, just 10 zip codes in the city accounted for 118,000 Medicaid enrollees. That alone lowered the uninsured rate by roughly 10 percent. The top 20 zip codes accounted for about 36 percent of the city's Medicaid surge.

In 2012, about 25 percent of Sunset Park West in Brooklyn lacked health insurance, according to the city's Human Resources Administration. The 11220 zip code, which overlaps with that neighborhood, saw 16,303 people sign up for Medicaid and another 1,667 enroll in a private health insurance plan. Flushing also had an uninsured rate above 25 percent and the 11355 zip code enrolled 13,434 in Medicaid and 2,203 signed up for a private plan. Corona's 11368 enrolled 12,480 people in Medicaid and 1,625 people in a private plan.

Much of this can be explained by the enormous investment the state and federal governments made to insure people across New York and the country. Community based organizations and immigrant advocacy groups spent months embedded in these neighborhoods explaining insurance options, and much of that activity was underwritten by the new law.

“These neighborhoods have had unprecedented levels of outreach and resources,” said Amy Shefrin, program officer at the New York State Health Foundation. “All these organizations are seeking out the uninsured in ways they never had before.”

The Affordable Care Act and a subsequent U.S. Supreme Court ruling allowed states the option of expanding their Medicaid programs, opening them up to a greater number of people. New York accepted this offer but its program was already so expansive the new law was not supposed to have much of an impact.

In 2011, the United Hospital Fund estimated the change in the number of Medicaid eligible individuals in the entire state would only be about 100,000. “Any increase in the take-up rate that A.C.A. inspires among already eligible individuals may ultimately be a much more significant issue in New York,” predicted a 2012 Independent Budget Report.

This is where the woodwork effect, also known as the welcome mat effect, appears to have played an enormous role. Because the state was advertising it's exchange, New York State of Health, and because so much press attention focused on enrollment, thousands of previously eligible New Yorkers enrolled.

“New York was ahead of the curve in making it easier to enroll but the ACA was the game changer,” Shefrin said. “It laid out a welcome mat for Medicaid. … There's a culture of coverage now.”